I get excess mucus in throat while talking with chest burning. Why?

Question

Hello doctor,

For two weeks now, I have been clearing my upper throat of what seems like excess mucus. It happens every few minutes when talking, but not when keeping quiet or sleeping. It almost feels like my upper esophagus fills with fluid when talking, and then I have to clear it. There is sometimes a mild burning in the upper chest.

I have GERD and am on 40 mg Nexium every day. This is not the same as normal reflux; I would feel it if I forgot to take my Nexium, and this is a lot higher up. I have seen an ENT who looked at my throat and larynx and said all is normal. Should I be worried about this?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Well, I do not think that you should be worried about this. As you rightly pointed out, this is not similar to common reflux that would otherwise occur in GERD. It is actually acid; however, they might be normal esophageal secretions that occur in response to GERD (gastroesophageal reflux syndrome). Our esophagus (food pipe) has sub-mucosal (the lining beneath the superficial lining of the esophagus) glands which produce viscous secretion, which smears the esophagus to make it moist and healthy.

In patients with GERD, this secretion is overly produced. Hence, you might be feeling that mucus in the upper part of the esophagus. Well, this may not be the only explanation for your sensation of that mucus feeling in your throat; there is one more thing called functional hypersensitivity. The nerves that carry signals of pain, touch, and temperature from the esophageal wall are hypersensitive. These nerves just pronounce everything they perceive, and the person now feels those normal secretions, or acid, as somewhat more sensitive than previously. And do occur when a person is awake and in the daytime.

Functional hypersensitivity can occur in anybody, not necessarily among patients with GERD. But definitely it more commonly affects patients with GERD.

So, how is it going to be treated?

1. Increase the dose of Nexium 40 gm to twice daily for a week and see if it helps.

2. Try to understand this and avoid or try ignoring it. Or like take a sip of water.

3. If nothing helps, really, then I may consider starting you on low-dose tricyclic antidepressants (TCA), which will control functional hypersensitivity.

I want to know how you feel about starting your TCA. These are antidepressants, but started on very low doses, not such much dosing which are given to treat depression. They are frequently associated with side effects, the common of which are dry mouth, dry eyes, constipation, and altered sleep. Let me know your side of this explanation and plan of action.

I hope this helps.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I understand your concern.

Yes, you just relax, this is nothing serious. The risk of esophageal cancer is very low, like 0.1% of all GERD patients. The patient who has chronic, uncontrollable symptoms of GERD for more than 10 years duration they have risk of developing Barrett's esophagus, which is a premalignant condition.

Out of such patients, only 1% develop esophageal cancer. So the risk is very low; it is seemingly negligible among individuals with controlled GERD. Just quickly go through my article, and you will have an idea of what I am talking about.

I hope this helps.

Thank you.